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1134499437
BRIANNE LARSEN BASTIAN
PROVO, UT
NPI
1134499437
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: UT 173414431)
Enumeration Date
2012-01-04
Last Update Date
2012-01-04
Business Address
-- BRIANNE LARSEN BASTIAN
750 N 200 W STE 300
PROVO, UT 84601-1690
Phone number: 801-373-4760
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Mailing Address
-- BRIANNE LARSEN BASTIAN
750 N 200 W STE 300
PROVO, UT 84601-1690
Phone number: 801-373-4760
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